Provider Demographics
NPI:1780099002
Name:MINGO, CHABRE (LCAS-A)
Entity type:Individual
Prefix:
First Name:CHABRE
Middle Name:
Last Name:MINGO
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:CHABRE
Other - Middle Name:
Other - Last Name:MINGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LACS-A
Mailing Address - Street 1:1615 WAYBRIDGE LN
Mailing Address - Street 2:APT 3B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210
Mailing Address - Country:US
Mailing Address - Phone:609-635-0771
Mailing Address - Fax:
Practice Address - Street 1:448 LAKESHORE PKWY
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4264
Practice Address - Country:US
Practice Address - Phone:803-329-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)